Indications, selection, and use of distant pedicled flap for upper limb reconstruction.

Despite the inherent advantages of free flaps for soft tissue cover in upper limb reconstruction, pedicled flaps remain the workhorse in many centers worldwide. Presumed disadvantages of pedicled flaps are that it requires multiple stages, longer hospital stay, are bulky, and primary reconstruction of composite defects cannot be done. Refinements in technique during planning can offset many of the disadvantages.

Experience with peroneus brevis muscle flaps for reconstruction of distal leg and ankle defects.

Objective: Peroneus brevis is a muscle in the leg which is expendable without much functional deficit. The objective of this study was to find out its usefulness in coverage of the defects of the lower leg and ankle.

Patients And Methods: A retrospective analysis of the use of 39 pedicled peroneus brevis muscle flaps used for coverage of defects of the lower leg and ankle between November 2010 and December 2012 was carried out.

Tips to orient pedicled groin flap for hand defects.

A groin flap is an axial-patterned cutaneous flap based on the superficial circumflex iliac arteriovenous system, which can provide soft-tissue coverage to defects on any aspect of the hand and the distal two thirds of the forearm. One of the presumed disadvantages of the pedicled groin flap is the discomfort experienced by the patient during the time required before flap division. These disadvantages can be greatly reduced by proper planning to orient the flap toward the defect, avoid any kinking at the base, and increasing the inset.

Wound coverage considerations for defects of the lower third of the leg.

Anatomical features of the lower third of the leg like subcutaneous bone surrounded by tendons with no muscles, vessels in isolated compartments with little intercommunication between them make the coverage of the wounds in the region a challenging problem. Free flaps continue to be the gold standard for the coverage of lower third leg wounds because of their ability to cover large defects with high success rates and feasibility of using it in acute situations by choosing distant recipient vessels. Reverse flow flaps are more useful for the coverage of the ankle and foot defects than lower third leg defects.

Nail bed injuries and deformities of nail.

Nail bed injuries are common and management of these requires good knowledge of the nail bed anatomy. Proper management of these injuries will ensure good healing and prevent late deformities. When loss occurs it is challenging to reconstruct which can be done by grafts or microsurgical reconstruction to restore aesthetic appearance of fingers.

Management of post burn hand deformities.

The hand is ranked among the three most frequent sites of burns scar contracture deformity. One of the major determinants of the quality of life in burns survivors is the functionality of the hands. Burns deformities, although largely preventable, nevertheless do occur when appropriate treatment is not provided in the acute situation or when they are part of a major burns.